<style type="text/css">
    .layui-layer-page .layui-layer-content{
        overflow: initial;
    }
</style>
<form style="padding:20px" class="layui-form normal" lay-filter="form-take-information-manage" id="form-take-information-manage" method="post" onsubmit="return false">
    <input type="hidden" name="id"/>
    <div class="layui-form-item">
        <label class="layui-form-label"><span class="text-danger">*</span>供应商名称</label>
        <div class="layui-input-block">
            <input type="text" lay-verify="required" name="supplierName" id="take-info-manage-supplier-name" class="layui-input required" placeholder="请输入供应商名称(支持模糊搜索)"/>
        </div>
    </div>
    <div class="layui-form-item">
        <label class="layui-form-label"><span class="text-danger">*</span>提货公司名称</label>
        <div class="layui-input-block">
            <input type="text" lay-verify="required" name="companyName" class="layui-input required" placeholder="请输入提货公司名称"/>
        </div>
    </div>
    <div class="layui-form-item">
        <label class="layui-form-label"><span class="text-danger">*</span>联系人</label>
        <div class="layui-input-block">
            <input type="text" lay-verify="required" name="linkPerson" class="layui-input required" placeholder="请输入联系人"/>
        </div>
    </div>
    <div class="layui-form-item">
        <label class="layui-form-label"><span class="text-danger">*</span>联系电话</label>
        <div class="layui-input-block">
            <input type="text" lay-verify="required" name="linkTel" class="layui-input required" placeholder="请输入联系电话"/>
        </div>
    </div>
    <div class="layui-form-item">
        <label class="layui-form-label"><span class="text-danger">*</span>提货区域</label>
        <div class="layui-input-block required-box">
            <div class="layui-col-md4">
                <select class="layui-input" lay-verify="required" lay-filter="take-info-manage-province" id="take-info-manage-province" name="provinceName"></select>
            </div>
            <div class="layui-col-md4" style="margin-left: -1px;">
                <select class="layui-input" lay-verify="required" lay-filter="take-info-manage-city" id="take-info-manage-city"  name="cityName" ></select>
            </div>
            <div class="layui-col-md4" style="margin-left: -1px;">
                <select class="layui-input" lay-verify="required" id="take-info-manage-area"  name="areaName" ></select>
            </div>
        </div>
    </div>
    <div class="layui-form-item">
        <label class="layui-form-label"><span class="text-danger">*</span>详细地址</label>
        <div class="layui-input-block">
            <input type="text" lay-verify="required" name="address" class="layui-input required" placeholder="例如：**街**号**"/>
        </div>
    </div>
    <div class="layui-row">
        <div class="fl pt10">
            <input type="checkbox" name="isDefault" lay-skin="primary" title="设为默认" value="true"/>
        </div>
        <button lay-submit lay-filter="add-take-info-manage-save" class="layui-btn fr"><i class="iconfont iconicon-1"></i>&nbsp;保存</button>
    </div>
</form>